1. Substance misuse services: Lancashire Chris Lee Public Health Lancashire County Council

2. History of substance misuse in Lancashire
Difficult history, under spends, poor services
Lacked design, no clear system, inequitable provision, unacceptable waiting times
Difficult commissioner/provider relationships
Varied performance
Lack of political support
Block contracts (substance misuse tied up with mental health)
Alcohol: Historically little funding, Long waiting lists, Very little performance data

3. Modernisation of adult treatment system
2008 – North Lancs – Integrated substance misuse services
2009 – East Lancs follows North and adds CJ
2009 – Central follows East adds IDTS
– further redesign in North and Central
Integrated prison and community
Recovery orientated, asset based, 5 Ways to Health and Wellbeing
Includes prison based therapeutic communities (2 of 4 nationally)

4. Present day Alcohol fully embedded in substance misuse services
Use all budgets as substance misuse
System designed to meet the needs of the population – not just opiate/alcohol (cannabis/stimulants/NPS)
Applied drug targets where alcohol target missing eg waiting times
Significantly improved performance: Successful completions growing, waiting times very low, improvement in wider outcomes – housing, employment, reducing injecting, growth in detox etc

5. Alcohol now equates to approx 2/3 of all referrals
Case loads still opiate dominated
Shorter ‘in treatment’ period for alcohol 89% of alcohol users in treatment 12 months or less (opiates – 34.4% 2 years or less; 28.8% 6 years plus)
Majority of community and inpatient detox = alcohol
Almost half of alcohol users living with children (less than 10% for opiate users)

6. AUDIT-C
(3 questions)
Where individual scores below 7, no further action required
Where individual scores 7+, ask remaining 7 AUDIT questions for total score
AUDIT
Score 0-7
AUDIT
Score 8 -15
AUDIT
Score 16+
Congratulate and reinforce benefits of lower risk drinking.
Complete Brief Assessment and Deliver ‘Brief Advice’
Signpost - groups/SMART/mutual aid/peer mentors
Open Access as per Strength based assessment Pathway
For Abstinent Service Users assessment sessions to be completed then refer directly to DEAP
To all who score
AUDIT 16+PLUS offer: Welcome group, 1 x Recovery plan session, 3 x sessions or delivered as 3 group work sessions, 1 exit session
SADQ score 20+ also refer to Alcohol Detox Team regarding medically assisted withdrawal and pre-detox group
SADQ 30+ offer above as appropriate and consider referral to Tier 4 as per pathway
seek advice from
Alcohol Detox Team regarding medically assisted withdrawal
Those who score Audit 16+ who require community alcohol detox will be encouraged to work on the alcohol sessions and attend pre-detox group, RAMP or Intuitive Recovery.
A referral to DEAP will be made where identified in the recovery plan.
People who cannot undertake the Sessions, or who work, can still access community detox: related clinical need will drive this journey

7. Issues
Professional resistance to joining drug and alcohol together (not from service users)
Dual diagnosis:
DD is the norm, not a rare event
Often present as
CJ issues
Homeless/housing need
History of service disengagement
Alcohol and cannabis (largest cohort)
MH issues
What appears to be a fragmented service response from MH
SM services commissioned to work with partners – will adapt to changes in partner providers etc
Sm services offer an inclusive approach
MH services commissioned differently
Exclusive approach, different teams with differing criteria, more fragmented
Liaison model difficult when one side commits and the other disengages.
Would be great to include SM providers and commissioners in MH redesign to ensure effective care pathways.

8. Thank you - Any questions?